Do stigma and its psychosocial impact differ between Asian-born Chinese immigrants and Western-born Caucasians with head and neck cancer?

Stigma appears to influence emotional distress and well-being in cancer survivors, but cross-cultural differences have been ignored. Previous studies suggest that stigma may be especially relevant for survivors of Asian origin. However, their study designs (e.g. focused on female cancers, qualitative designs, and an absence of comparison groups) limit the strength of this conclusion. We hypothesized that (1) Asian-born Chinese immigrants (AI) would report more perceived cancer-related stigma than Western-born Caucasians (WBC); and (2) the impact of stigma on emotional distress and well-being would be greater in AI as compared to WBC. Head and neck cancer survivors (n = 118 AI and n = 404 WBC) completed measures of well-being, emotional distress, and a three-item indicator of stigma in structured interviews. The majority of respondents (59%) reported one or more indicators of stigma. Stigma correlated significantly with emotional distress (r = .13, p = .004) and well-being (r = ?.09, p = .032). Contrary to our hypotheses, WBCs and AIs did not differ in reported stigma nor did we detect differences in its psychosocial impact. Stigma exerts a deleterious psychosocial impact on head and neck cancer survivors. It did not differ significantly between AI and WBC survivors.     

Job characteristics,well-being and risky behaviour amongst pharmacists

Healthcare practitioners’ fitness to practise has often been linked to their personal and demographic characteristics. It is possible that situational factors, such as the work environment and physical or psychological well-being, also have an influence on an individual’s fitness to practise. However, it is unclear how these factors might be linked to behaviours that risk compromising fitness to practise. The aim of this study was to examine the association between job characteristics, well-being and behaviour reflecting risky practice amongst a sample of registered pharmacists in a region of the United Kingdom. Data were obtained from a cross-sectional self-report survey of 517 pharmacists. These data were subjected to principal component analysis and path analysis, with job characteristics (demand, autonomy and feedback) and well-being (distress and perceived competence) as the predictors and behaviour as the outcome variable. Two aspects of behaviour were found: Overloading (taking on more work than one can comfortably manage) and risk taking (working at or beyond boundaries of safe practice). Separate path models including either job characteristics or well-being as independent variables provided a good fit to the data-set. Of the job characteristics, demand had the strongest association with behaviour, while the association between well-being and risky behaviour differed according to the aspect of behaviour being assessed. The findings suggest that, in general terms, situational factors should be considered alongside personal factors when assessing, judging or remediating fitness to practise. They also suggest the presence of different facets to the relationship between job characteristics, well-being and risky behaviour amongst pharmacists.     

Health behaviour change theory meets falls prevention: Feasibility of a habit-based balance and strength exercise intervention for older adults

ObjectivesHabit formation is a proposed mechanism for behaviour maintenance. Very few falls prevention studies have adopted this as an intervention framework and outcome. Therefore, we tested feasibility of a theory-based behaviour change intervention that encouraged women to embed balance and strength exercises into daily life routines (e.g., eating, self-care routines).DesignThe EASY LiFE study was a mixed-methods, 4-month feasibility intervention that included seven group-based sessions and two telephone calls.Main outcome measuresWe obtained performance-based (i.e., Short-Physical-Performance-Battery) and psychological self-report measures (i.e., intention, self-efficacy, planning, action control, habit strength, quality of life) from 13 women at baseline (T1) and 4-month follow-up (T2). We applied the Framework-Method to post-intervention, semi-structured interviews to evaluate program content and delivery.ResultsIn total, 10 of 13 women completed the program (M_age = 66.23, SD = 3.98) and showed changes in their level of action control [mean difference_T1−T2 = 1.7, 95% CI (−2.2 to −0.8)], action planning [mean difference_T1−T2 = 0.8, 95% CI (−1.1 to −0.2)], automaticity [mean difference_T1−T2 = 2.5, 95% CI (−3.7 to −1.2)], and exercise identity [mean difference_T1−T2 = 2.0, 95% CI (−3.2 to −0.8)]. Based on the Theoretical Domains Framework we identified knowledge, behavioural regulation, and social factors as important themes. For program delivery, dominant themes were engagement, session facilitators and group format.ConclusionThe theory-based framework showed feasibility for promoting lifestyle integrated balance and strength exercise habits. Using activity and object-based cues may be particularly effective in generating action and automaticity.     

Communicating power and resistance: exploring interactions between aboriginal youth and non-aboriginal staff members in a residential child welfare facility

Aboriginal youth are highly overrepresented within the child welfare system. High-risk youth are often placed in out-of-community residential placements. Such residential placements have been described by some as a continuation of colonial practices. Using communication theory as a conceptual model, we propose a qualitative analysis of micro-interactions that take place between Aboriginal youth and non-Aboriginal workers during the management of high-risk behaviors within a residential program. Three broad categories of interaction emerge from the data: complementary, symmetrical/complementary (where youth show a form of submission despite resistance), and symmetrical (characterized by a power struggle). Despite the diversity of interactions along this symmetrical to complementary continuum, interventions always start and finish in the same fashion. Moreover, the nature of interactions depended mostly on how quickly youth accepted the consequences of their behaviors. We also extracted five categories related to culture, race or context that are perceived as influencing the interactions that take place between staff and youth. The analysis of micro-interactions within clinical, organizational, social and historical contexts points to mechanisms by which asymmetrical power relations may be replicated on a day-to-day basis despite the best intentions of residential workers.     

The War Between Faith and Fact

Is there a war going on between science and religion or not? The Center for Theology and the Natural Sciences and many other bridge-building advocates deny that a war must be fought between genuine science and authentic faith. Yet, a new book, Faith vs. Fact, by Jerry Coyne, launches a new attack against those with faith in God. This essay asks whether such an attack comes from genuine science or from scientism—a materialist ideology that claims rational science as its ally.     

Aboriginal Health Care and Bioethics: A Reflection on the Teaching of the Seven Grandfathers

Contemporary bioethics recognizes the importance of the culture in shaping ethical issues, yet in practice, a process for ethical analysis and decision making is rarely adjusted to the culture and ethnicity of involved parties. This is of a particular concern in a health care system that is caring for a growing Aboriginal population. We raise the possibility of constructing a bioethics grounded in traditional Aboriginal knowledge. As an example of an element of traditional knowledge that contains strong ethical guidance, we present the story of the Gifts of the Seven Grandfathers. We note a resemblance of this Ojibway teaching to virtue ethics in European traditions, but we suggest that there are also important differences in how these two traditions are currently presented. We hope that further engagement with a variety of indigenous moral teachings and traditions could improve health care involving Aboriginal patients and communities, and enrich the discipline of bioethics.     

The “Jewish Knight” of Slobodka honor culture and the image of the body in an Ultra-Orthodox Jewish context

Scholarship on Ultra-Orthodox Jewish thought has traditionally assumed that the views of these communities derive from a struggle against the Jewish Enlightenment and Zionism, as well as against any values they identify as “modern.” This article challenges that assumption. Beginning with an examination of Ultra-Orthodox sources that present an image of the religious leader as the “ideal Jew,” the author then focuses on sources concerning the founder of the Slobodka Yeshiva in Lithuania. This rabbi intended his students to internalize “modern” norms found in the European honor culture of his time, while translating them into the language of Jewish Ultra-Orthodoxy. The author chooses to present his argument by tracing the image of the body in the Slobodka method, since it is precisely through the nexus of the body that Ultra-Orthodox Judaism was segregated from general European society and culture.     

Drugs,Sex, and Condoms: Identification and Interpretation of Race‐Specific Cultural Messages Influencing Black Gay and Bisexual Young Men Living with HIV

Black gay and bisexual young men carry a disproportionate burden of HIV in the United States. This study explored Black gay and bisexual young men living with HIV's identification and interpretation of race‐specific cultural messages regarding substance use, sexual activity, and condom use. A total of 36 Black gay and bisexual young men living with HIV (ages 16–24, mean = 20.6 years) from four geographically diverse regions of the United States participated in qualitative in‐depth interviews. Results from this study elucidate the ways in which these young men interpret various forms of race‐specific cultural messages and experiences regarding substance use, sexual activity, and condom use. Participants discussed cultural messages and experiences promoting and discouraging condoms and substance use. Regarding sexual activity, only messages and experiences promoting sex were reported. Across all three categories, messages and experiences promoting risk were predominant. Data further revealed that socially transmitted cultural messages received by young men emanated from multiple sources, such as family, peers, sexual partners, community/neighborhood, and the broader society. Race‐specific cultural messages and experiences should be addressed in interventions for this population, and programs should assist young men in developing a critical consciousness regarding these messages and experiences in order to promote health and well‐being.